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THIS FORM MUST eE SUBMITTED <br />WITHIN fi0 DAYS OF COMPLETION <br />OF THE WORK DESCRIBED HERE- <br />ON. TYPE OR PRINT IN BLACK <br />INK. <br />~LOWNER ~~~'I'T ~-ee /~~ <br />ADDRESS ~7~0 ll~esTr-~//-~Pd . <br />~ ke woo ~ F/ot: oTa 9.~~3 <br />DATE COMPLETED •5~~~' , 19~ <br />WELL LOG <br /> <br />From <br />To <br />Type and Color of Material Water <br />Loc. <br />o ~ Soi ~ <br /> <br />~s ~/ S~.vdtcGlC <br />a 7 7~, s~tid~-o ~ k war r; <br /> <br /> <br /> <br /> <br />16 9~ s~,vo~H~~k w;T <br /> %;,,. L~y~ r 5 of <br /> <br /> ~J ~ / <br />TOTAL DEPTH ___/ <br />Use additional pages necessary to complete log <br />V VL.VrsMUV L111fIJI VIV Un yy F~iEi; f1CJV UiII.GJ <br />1313 Sherman Street ~ Room 318 <br />Denver, Colorado 80203 <br />~'/. of the 'sv•~ % of Sec. ~~ , <br />~j~ ` 6 ~ ~ G '-N P.M. <br />T.1.~Z_..~L.-. R. <br /> <br />STAtI ~ tK~!KiE~ <br />Yt r <br /> <br />WELL COMPLETION AND PUMP INSTALLATION REPORT <br />PERMIT NUMBER ~~.~LL ~.~ <br />HOLE DIAMETER <br />in. from ~ to q~ ~ It. <br />_~ in. Irom ~~ to ~/ ~ It. <br />in. from _._._ to ./ _It. <br />DRILLING METHOD [ ~-40~ ~n <br />CASING RECORD: Plain Cssinq <br />// <br />Size ~ & kind s e from ~ to a O ft. <br />Size __._ & kind _ from _._ to,__ ft. <br />Size __ & kind _ from to ft. <br />D~e N // ~~~sinq <br />Size _._._ & kind _.____.. from .__ to ft. <br />Size -__ & kind ___-from _ to ft. <br />Size ____ & kind _____ _ from to __ ft <br />GROUTING RECORD <br />Material -_~~~?~.~ C.:r_~d~~_~lLZ <br />Intervals .._P. ~~~ <br />Placement Method ~~~ ~" <br />GRAVEL PACK: Size__._ <br />Interval <br />TEST DATA <br />Date Tested _~7~~ 19 <br />Static Water Level Priorpto`Test/_.._ ~ ft. <br />Type of Test Pump ~~ d <br />Length of Test ~i~V' s ~ ~~ <br />Sustained Yield-4A4wKSd) ~~ G"~L=-- <br />Final Pumping Water Level _ ~i~_ <br />